REPUBLIC OF THE PHILIPPINES }

DONE: IN THE CITY OF BAGUIO } S.S.

X ======================== X

AFFIDAVIT OF CONSENT OF USE OF SURNAME

I, NORMAN D. DELA CRUZ, single, of legal age, Filipino citizen and with residence and
postal address at #18 Phil-Am Compound, Baguio City, after having been sworn to in accordance
with law hereby deposes and states that:

1. I had been living with Aleli Joy Bautista, also of legal age and Filipino Citizen since 2001 and
the same is true until the present time;

2. As a result of our relationship and our love and affection toward each other, we were blessed
with two healthy children;

3. Our first child, ALMIE BAUTISTA, was born in July 27, 2001 and our second child MIEL
BAUTISTA was born in November 24, 2003;

4. To affirm my Affidavit of Acknowledgment as their natural and biological father, I hereby

allow my two children to use my surname DELA CRUZ;

5. ALMIE BAUTISTA and MIEL BAUTISTA who had been using the surname of their mother
may now use my own surname and will now then be ALMIE BAUTISTA DELA CRUZ and
MIEL BAUTISTA DELA CRUZ;

6. I hereby attest to the truthfulness of the above statements for all legal intents and purposes
it may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this 25 th day of February 2011, in the
City of Baguio, Philippines.

NORMAN D. DELA CRUZ

Affiant
CTC NO. 13160576
Issued on January 25, 2011
Issued at Baguio City

SUBSCRIBED AND SWORN to before me in the City of Baguio this 25 th day of February 2011,
by Norman D. Dela Cruz, who has satisfactorily proven his identity through:

JEY T. PONCE, with Passport No. XX81283, valid until February 14, 2016.
MA. REMEDIOS BELLO, with Passport No. TT83084, valid until April 18, 2013.

who personally know the principal, to be the same person who executed and personally signed the
foregoing affidavit before me and acknowledged that he executed the same.

LIYA ORTEGA-
RODRIGUEZ
Notary Public
Until December 31, 2012
Doc. No. __ 23_; PTR No. 050183/Baguio City/01-11-11
Page No. __5__; Roll of Atty. No. 8121983
Book No. I ; IBP Lifetime Membership No. 9031984
Series of 2011. Baguio-Benguet